Association With Low Muscle Mass And Chronic Complications In Elderly Patients With Type 2 Diabetes Mellitus

Objective: The study aimed to explore association with low muscle mass and chronic complications in elderly patients with type 2 diabetes mellitus.Methods: 128 patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology,Zhongda Hospital Affiliated to Southeast University from June 2017 to June 2018,including 58 males and 70 females,aged 60-83 years,all subjects were eligible for T2 DM.The diagnostic criteria and exclusion criteria were collected by questionnaire and the patient’s general condition was compared with serological examination to obtain clinical data.Dual energy X-ray Absorptiometry(DXA)was used to examine muscle mass and body fat percentage in various parts of the body.The diagnosis of muscle mass reduction was evaluated by the Skeletal Muscle Index(SMI).Below 7.01kg/m2,women below 5.42 kg/m2 are diagnostic criteria.The urine microalbumin/creatinine ratio(ACR)was used as a measure of proteinuria.According to the ACR value,Diabetic Nephropathy(DN)was determined.The subjects were divided into two groups: diabetic nephropathy(DN)group.(ACR ≥ 30 ug / mg for more than 3 months)and non-diabetic nephropathy(NDN)group(ACR < 30 ug / mg).A fundus examination performed by the same ophthalmologist to determine the presence or absence of Diabetic Retinopathy(DR),exclusion of diabetic nephropathy and/or diabetic peripheral neuropathy,was divided into three groups: non-diabetic retinopathy group(NDR),non-proliferation Diabetic retinopathy group(NPDR)and proliferative diabetic retinopathy group(PDR).Diabetic Peripheral Neuropathy(DPN)was determined by neurophysiological examination,and diabetic nephropathy and/or diabetic retinopathy were excluded.They were divided into two groups: diabetic peripheral neuropathy group(DPN)and non-diabetic peripheral nerve.Lesion group(NDPN).Further analysis of skeletal muscle mass index(SMI)and skeletal muscle mass(Appendicular-Skeletal Muscle Mass(ASMM),Waist-to-Hip Ratio(WHR),age,duration of diabetes,glycosylated hemoglobin(Glycosylated Hemoglobin,HbA1c)The correlation between indicators and other indicators to explore the correlation between three common chronic complications and muscle mass reduction in elderly type 2 diabetes.Results: 1.Overall and Grouping:Of the 128 patients with type 2 diabetes,46(including 35.9% of all subjects),23 patients with diabetic retinopathy(17.9% of all subjects),and 40 patients with diabetic peripheral neuropathy(31.4% of all subjects)),19 patients without complications(accounting for 14.8% of all subjects).2.Diabetic nephropathy group : Among the diabetic nephropathy group,the age of subjects,serum creatinine,ACR,skeletal muscle mass,waist-to-hip ratio(WHR),triglyceride,total cholesterol,and low-density lipoprotein were higher than those in the non-diabetic nephropathy group.Body weight,body mass index,systolic blood pressure,Glutamic-Pyruvic Transaminase,Glutamic Oxalacetic Transaminase,uric acid,fasting blood glucose(Fasting Plasma Glucose and glycosylated hemoglobin(Hemoglobin A1 c,HbA1c)were not significantly different between the two groups(P>0.05).In addition,the SMI and estimated glomerular filtration rate measured in the DN group were lower than those in the non-DN group,and the diagnostic criteria for muscle mass reduction proposed by the Asian muscular dystrophy(AWGS)were detected.The diabetic nephropathy group was detected.The muscle mass decreased in 18 cases(32.6%),and the non-DN group detected a decrease in muscle mass in 4 cases(16.7%).The difference in the detection rate between the two groups was statistically significant(χ2=4.725,P<0.05).Logistic regression stepwise analysis showed that muscle reduction was independently associated with diabetic nephropathy(OR 0.382,[95% CI: 0.283 to 0.558],P < 0.001).3.Diabetic retinopathy group:In the diabetic retinopathy group,subjects had lower SMI,skeletal muscle mass,estimated glomerular filtration rate and than non-diabetic retinopathy group,while age,diabetes duration,ACR,systolic blood pressure,WHR were higher,height,weight,BMI,Glutamic-Pyruvic Transaminase,Glutamic Oxalacetic Transaminase,uric acid,fasting blood glucose,glycosylated hemoglobin,etc.were not statistically significant(P>0.05).Adjusting for age,gender,and BMI,the results showed a significant association between PDR and sarcopenia(OR=6.48,[95% CI: 1.34 to 17.81],P< 0.01).4.Diabetic peripheral neuropathy group:The SMI,skeletal muscle mass,estimated glomerular filtration rate,in the diabetic peripheral neuropathy group were lower than those in the non-DPN group,but the age,duration of diabetes,ACR,systolic blood pressure,WHR,low-density lipoprotein,triglyceride,and total cholesterol were higher.Height,weight,BMI,uric acid,fasting blood glucose,glycosylated hemoglobin,etc.were not statistically significant(P>0.05).Compared with the non-DPN group,the muscle mass decreased with the SMI of the DPN group significantly decreased(6.23±1.30 vs.7.11±1.04 kg/m2,P<0.05).Compared with the non-DPN group,the proportion of muscle reduction in the DPN group was significantly higher(52.5% vs.10.8%,P< 0.001).Univariate logistic regression analysis showed that muscle mass loss was associated with high risk of DPN(OR=2.13 [95% CI: 1.89-2.43],p<0.01).Further multivariate logistic regression analysis was used to obtain the conclusions consistent with the above(OR=2.06 [95% CI: 1.34~3.35],p<0.01).Conclusion: 1.The detection rate of muscle mass reduction in DN group is higher than that in NDN group.The decrease of muscle mass is an independent risk factor for proteinuria.Diabetic nephropathy is associated with muscle mass reduction.Therefore,proteinuria detection is performed in patients with T2 DM.Attention should be paid to the reduction of muscle mass,increase awareness of muscle reduction,and slow the progression of diabetic nephropathy.2.The detection rate of muscle mass reduction in NPDR or PDR was higher than that in NDR,but there was no significant correlation between the DR and muscle mass reduction.3.The detection rate of muscle mass reduction in the PDN group of elderly T2 DM patients was higher than that of the NPDN group.DPN was associated with decreased muscle mass in patients with type 2 diabetes.In patients with diabetic peripheral neuropathy,the detection rate of sarcopenia should be emphasized,and the progression of sarcopenia should be slowed down.